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Kyung Soo Woo, Su Hyun Bong, Tae Young Choi, Jun Won Kim Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of KoreaCorrespondence: Jun Won KimDepartment of Psychiatry, Daegu Catholic University School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of KoreaTel +82-53-650-4332Fax +82-53-623-1694Email f_affection@naver.comPurpose: The excessive use of smartphones for social interaction is associated with mental health. However, few studies have considered the purpose of smartphone usage and screen time together. Therefore, we investigated the impact of smartphone purpose and screen time on mental health using data from the 2017 Korea Youth Risk Behavior Web-based Survey (KYRBS).Participants and Methods: A total of 54,243 adolescents answered items on purpose and screen time of smartphone use, stress perception, sleep dissatisfaction, depressive symptoms, and suicide-related indicators. The purpose of smartphone usage was categorized as social interaction and non-social interaction, and the daily smartphone screen time was classified into three categories: < 2 hours, ≥ 2 hours but < 4 hours, ≥ 4 hours per day.Results: We determined that, on weekdays, stress perception, sleep satisfaction, depressive symptoms, and suicide-related indicators worsened in both groups that used smartphones for ≥ 4 hours per day. When using smartphone for ≥ 2 hours but < 4 hours per day on weekdays, depending on the smartphone use purpose, mental health outcomes differed between the two groups. On weekends, using smartphones for ≥ 2 hours but < 4 hours per day worsened sleep satisfaction but decreased suicide-related indicators in both groups. Mental health outcomes improved when participants used smartphones for ≥ 2 hours but < 4 hours per day but worsened when smartphones were used for ≥ 4 hours per day on weekends.Conclusion: Recommended screen time of smartphone is different depending on the purpose of smartphone use, and the risk of uncontrolled usage is emphasized, rather than the absolute screen time.Keywords: mental health, smartphone addiction, social interaction, social media

Purpose: Residual functional ankle instability regardless of the restoration of mechanical stability after the lateral ligament repair or reconstruction can cause recurrent sprain. The purpose of this study was to identify the sequential changes of joint-position sense, peroneal strength, postural control, and functional performance ability after the modified Broström procedure (MBP) for chronic ankle instability. Methods: A total of 46 patients (46 ankles) who underwent the MBP for chronic ankle instability were eligible for this study and were followed up for 1 year postoperatively. The changes of joint-position sense and peroneal strength were periodically evaluated with an isokinetic dynamometer. Postural control ability was evaluated using a one-leg stance test with eyes closed. The functional performance ability examination comprised a one-leg hop test, a six-meter hop test, and a cross three-meter hop test. Results: The error in joint-position sense significantly improved from a mean 4.3° to 2.8° ( p < 0.001). Peak torque for eversion significantly improved from a mean 18.2 Nm to 21.2 Nm ( p = 0.024). Balance retention time significantly improved from a mean 4.7 s to 6.4 s ( p < 0.001). Among the functional performance tests, only the one-leg hop test showed a significant improvement postoperatively ( p = 0.031). At 1 year postoperatively, the recovery ratios compared to the unaffected ankle were 67.9% in joint-position sense ( p < 0.001), 86.9% in peroneal strength ( p = 0.012), and 74.4% in postural control ( p < 0.001), with significant side-to-side differences. Conclusion: Although joint-position sense, peroneal strength, postural control, and functional performance ability were significantly improved after the MBP, recovery ratios compared to the unaffected ankle were insufficient up to 1 year postoperatively. Level of Evidence: Level IV (prospective case series)

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Objectives To investigate peripapillary retinal nerve fiber layer (pRNFL) changes in patients with progressive supranuclear palsy (PSP). Methods We included 21 PSP patients (36 eyes) who underwent peripapillary optical coherence tomography (OCT) scans at 2.5 ± 1.3 years of disease, without ophthalmologic co-morbidities. We compared pRNFL thicknesses in PSP eyes with age-matched 22 controls (22 eyes) using generalized estimating equation model adjusting for intra-subject inter-eye correlations, age and sex. We also analyzed the correlation between the pRNFL thickness and clinical severity using Spearman’s correlation. In twelve PSP patients with 3 T brain MRI volumetric scan within 1 year of OCT exam, we investigated the correlation between the pRNFL thickness and brain atrophy using Pearson’s correlation. Results PSP patients had global pRNFL thinning compared to controls (beta = − 6.436, p = 0.025). Global pRNFL thickness correlated with Hoehn & Yahr stages (r = − 0.487, p = 0.025), and nasal pRNFL thinning showed a trend of correlation (uncorrected p p = 0.008) and urinary incontinence (uncorrected p = 0.031), although not significant after Bonferroni correction (all 28 items). The patients had significant atrophy in the posterior cingulate cortex, third ventricle, pallidum, and midbrain with reduced midbrain-to-pons ratio, but no correlation was found between pRNFL thickness and brain volumes. Conclusion The pRNFL seems to be affected in PSP, which is more severe with advanced disease stages. Retinal investigation in a larger longitudinal cohort would help elucidate the pathophysiological role of retinal thinning in PSP.

OBJECTIVE Wound infection is prevalent in home healthcare (HHC) and often leads to hospitalizations. However, none of the previous studies of wounds in HHC have used data from clinical notes. Therefore, the authors created a more accurate description of a patient's condition by extracting risk factors from clinical notes to build predictive models to identify a patient's risk of wound infection in HHC. METHODS The structured data (eg, standardized assessments) and unstructured information (eg, narrative-free text charting) were retrospectively reviewed for HHC patients with wounds who were served by a large HHC agency in 2014. Wound infection risk factors were identified through bivariate analysis and stepwise variable selection. Risk predictive performance of three machine learning models (logistic regression, random forest, and artificial neural network) was compared. RESULTS A total of 754 of 54,316 patients (1.39%) had a hospitalization or ED visit related to wound infection. In the bivariate logistic regression, language describing wound type in the patient's clinical notes was strongly associated with risk (odds ratio, 9.94; P < .05). The areas under the curve were 0.82 in logistic regression, 0.75 in random forest, and 0.78 in artificial neural network. Risk prediction performance of the models improved (by up to 13.2%) after adding risk factors extracted from clinical notes. CONCLUSIONS Logistic regression showed the best risk prediction performance in prediction of wound infection-related hospitalization or ED visits in HHC. The use of data extracted from clinical notes can improve the performance of risk prediction models.

Orbital actinomyces is a rare diagnosis with only a few cases reported in the literature. It can be difficult to diagnose due to its slow, indolent course, and nonspecific findings on imaging and clinical examination, and frequently it can masquerade as other pathologies such as neoplasm and inflammatory disease. The authors present a case of actinomyces masquerading as meningioma with findings of hyperostosis and a superior orbital roof interosseous tract on imaging.

Premature fusion of the cranial suture and midface hypoplasia are common features of syndromic craniosynostosis caused by mutations in the FGFR2 gene. The only treatment for this condition involves a series of risky surgical procedures designed to correct defects in the craniofacial bones, which must be performed until brain growth has been completed. Several pharmacologic interventions directed at FGFR2 downstream signaling have been tested as potential treatments for premature coronal suture fusion in a mouse model of Apert syndrome. However, there are no published studies that have targeted for the pharmacologic treatment of midface hypoplasia. We used Fgfr2S252W/+knock-in mice as a model of Apert syndrome and morphometric analyses to identify causal hypoplastic sites in the midface region. Three-dimensional geometric and linear analyses of Fgfr2S252W/+mice at postnatal day 0 demonstrated distinct morphologic variance. The premature fusion of anterior facial bones, such as the maxilla, nasal, and frontal bones, rather than the cranium or cranial base, is the main contributing factor toward the anterior-posterior skull length shortening. The cranial base of the mouse model had a noticeable downward slant around the intersphenoid synchondrosis, which is related to distortion of the airway. Within a skull, the facial shape variance was highly correlated with the cranial base angle change along Fgfr2 S252W mutation–induced craniofacial anomalies. The inhibition of an FGFR2 downstream signaling enzyme, PIN1, via genetic knockdown or use of a PIN1 inhibitor, juglone, attenuated the aforementioned deformities in a mouse model of Apert syndrome. Overall, these results indicate that FGFR2 signaling is a key contributor toward abnormal anterior-posterior dimensional growth in the midface region. Our study suggests a novel therapeutic option for the prevention of craniofacial malformations induced by mutations in the FGFR2 gene.

The distribution of rhodoliths growing near the Udo islands in the Republic of Korea was identified and the controlling factors influencing their growth and distribution were investigated. Their mineralogical and textural features of growth patterns and the physical oceanographic properties that influence the rhodolith distribution were also examined. The study area is relatively shallow with a water depth of less than 20 m and thus is influenced by seasonal typhoons and winter storms as well as wind-driven waves and strong tidal currents. The study site was divided into four areas based on the distribution of the rhodoliths and the associated physical and biological factors. The bedrock-exposed area partially covered with live rhodoliths (area I) at depths of up to 10 m provides an environment characterized by high wave energy and irregular seabed topography, which precludes continuous rhodolith growth and accumulation. Living rhodoliths were rarely observed and the sediments continuously migrate to adjacent beaches and shallow waters. The depth range of 10–15 m can be divided into the northern (the active growth area of live rhodoliths, area II) and southern (the sand dune area with dead rhodoliths, area III) areas. The southern part, where underwater sand dunes appear, is predominantly distributed with sandy sediments and ripple marks, which makes it an adverse environment for continuous growth of rhodoliths. In contrast, the northern part has a bowl-shaped seabed with gentle slopes, providing a stable condition for the constant and active growth of rhodoliths. In areas deeper than 15 m (the seagrass-covered area with live rhodoliths, area IV), an irregular seabed topography is present and the wave energy is reduced. Consequently, various sizes of rhodoliths with bumpy surfaces are distributed throughout this area. Therefore, it is suggested that the distribution of the rhodoliths is affected by the bottom topography and the associated physical energy, in conjunction with different types of surface sediments. The results of this study will increase the understanding of rhodoliths elsewhere in the world.

Purpose To evaluate the surgical outcome and safety of acellular human dermal allograft as a new lining material to the exposed orbit after exenteration. Methods Retrospective case series of patients who underwent orbital exenteration followed by reconstruction with meshed-type acellular dermal allograft from 2009 to 2018 in a single tertiary institution. Results There were 14 eyes (2 right, 12 left) of 14 patients (6 men, 8 women). Mean age at operation was 69.1 ± 16.5 years. Indication for surgery was malignancy in all patients. One patient underwent subtotal exenteration, while the rest underwent total exenteration. SureDerm Meshed was used in 12 patients, AlloDerm Meshed in 1, and CGDerm Meshed in 1. Mean follow-up period was 12.1 months. Full or nearly full epithelialization occurred in 10 of 14 patients (71.4%) at 1 month and 9 of 12 patients (75.0%) at 3 months. There was delayed epithelialization in 3 patients due to poor wound care (n = 1), adjuvant radiotherapy (n = 1), and adjuvant radiotherapy followed by cerebrospinal fluid leak (n = 1). Conclusions Meshed acellular human dermal allograft showed good success in reconstruction after orbital exenteration and may be considered as an alternative lining material to split-thickness skin graft after orbital exenteration.

Growth and differentiation factor 11 (GDF11) is a transforming growth factor β family member that has been identified as the central player of anterior–posterior (A–P) axial skeletal patterning. Mice homozygous for Gdf11 deletion exhibit severe anterior homeotic transformations of the vertebrae and craniofacial defects. During early embryogenesis, Gdf11 is expressed predominantly in the primitive streak and tail bud regions, where new mesodermal cells arise. On the basis of this expression pattern of Gdf11 and the phenotype of Gdf11 mutant mice, it has been suggested that GDF11 acts to specify positional identity along the A–P axis either by local changes in levels of signaling as development proceeds or by acting as a morphogen. To further investigate the mechanism of action of GDF11 in the vertebral specification, we used a Cdx2‐Cre transgene to generate mosaic mice in which Gdf11 expression is removed in posterior regions including the tail bud, but not in anterior regions. The skeletal analysis revealed that these mosaic mice display patterning defects limited to posterior regions where Gdf11 expression is deficient, whereas displaying normal skeletal phenotype in anterior regions where Gdf11 is normally expressed. Specifically, the mosaic mice exhibited seven true ribs, a pattern observed in wild‐type (wt) mice (vs. 10 true ribs in Gdf11 −/− mice), in the anterior axis and nine lumbar vertebrae, a pattern observed in Gdf11 null mice (vs. six lumbar vertebrae in wt mice), in the posterior axis. Our findings suggest that GDF11, rather than globally acting as a morphogen secreted from the tail bud, locally regulates axial vertebral patterning.

Background/ Objectives: This paper aims to reliably evaluate the torque ripple of an optimal designed 3-phase induction motor using the measurement uncertainty theory. Methods/ Statistical analysis: The measurement uncertainty theory is statistically applied to the actual test. To apply the measurement uncertainty theory to the simulation result such as torque ripple, the type-A standard uncertainty can be calculated through the periodical calculation of torque ripple and the type-B standard uncertainty expressing non-statistical factors such as measurement environment, instrument or method is regarded as 0 in the uncertainty evaluation process. Findings: The general expression of torque ripple of an optimal designed 3-phase induction motor is not dependable because of the fluctuating torque at steady state. Therefore, in this paper, the uncertainty of the torque ripple is evaluated by using the type-A and the type-B standard uncertainty which is regarded as 0. As a result, the torque ripples before and after the optimal design are reliably evaluated in a specific confidence level. Also, it is known that the uncertainty can be easily applied to the torque ripple as well as other motor parameters such as power loss, output power density and so on. Improvements/ Applications: Since this paper deals with evaluation method of torque ripple of a 3-phase induction motor with respectively low torque ripple, it could be applied to motors with large torque ripple.

이 연구에서는 국내 미충족 의료의 현황과 영향요인을 살펴보고, 향후 미충족 의료 정책의 기초자료를 제공하고자 체계적 문헌고찰을 수행하였다. 2017년 12월 15일 이전 국내 학술 데이터베이스에 출판된 45편의 논문을 분석에 포함하였다. 분석 내용은 미충족 의료의 정의, 연구에서 나타난 미충족률 현황과 미충족 의료의 영향요인이다. 자료원별로 미충족 의료의 정의가 다양하여 일반적, 경제적, 시간적 요인에 의한 미충족의료 3가지 유형으로 나눈 후 분석을 진행하였다. 발행시기별 연구 현황으로는 2010년 이후 발간된 논문의 수가 증가함을 알 수 있었으며, 연구대상자는 성인 17편(37.8%), 가구 13편 (28.8%), 노인 9편(20.0%), 장애인 3편(6.7%), 여성 2편(4.4%), 청소년 1편(2.2%) 순이었다. 분석자료원은 주로 한국의료패널 15편(33.3%), 국민건강영양조사 11편(24.4%), 한국복지패널 6편(13.3%)과 같은 2차 자료를 이용하였다. 연구에서 나타난 미충족률 현황 중 대상자에 따른 미충족률은 가구의 경우 5.54%(2005), 1.4%(2009), 2.1%(2013)로 일정하지 않았다. 성인의 경우 14.89%(2011), 16.38%(2012), 17.64%(2013), 노인의 경우 13.5%(2011), 16.9%(2012), 18.9%(2013)로 전반적으로 증가하는 경향을 보였다. 경제적 요인에 의한 미충족률은 성인의 경우 27.98%(2011), 36.35%(2012), 35.67%(2013)로 증가하는 추세이나 노인의 경우 55.9%(2011), 36.6%(2012), 42.8%(2013)로 일정하지 않았다. 시간적 요인에 의한 미충족률은 성인의 경우 30.03%(2011), 34.38%(2012), 35.59%(2013)로 증가 추세를 보였으며, 노인의 경우 10.0%(2011), 29.4%(2012), 14.3%(2013)로 일정하지 않았다. 미충족 의료의 영향요인은 성별, 연령, 교육수준, 배우자 유무, 가구소득, 경제활동유무, 의료보장 유형, 주관적 건강상태, 만성질환 유무, 우울감 유무, 활동제한으로 나타났다. 기존 연구에서 미충족 의료 양상은 시기, 대상자, 지표, 자료원에 따라 상이한 결과를 보였다. 향후 보다 정확한 정의에 기반을 둔 지표의 세분화, 표준화와 함께 미충족 의료에 대한 완결된 조사설계를 기반으로 체계적인 모니터링이 필요하며, 대상자의 특성에 따른 대책 마련이 필요함을 확인하였다.

State-selective deactivation rates of N-methylpyrrole in the S1 state have been measured by using the picosecond pump–probe method. The S1 decay time leading to the N–CH3 bond dissociation is found to be strongly mode-dependent as manifested in both S1 decay and methyl-fragment growth dynamics. Time-resolved velocity-map ion images of the ˙CH3 fragment, as far as the fragment of the Gaussian-shaped high kinetic energy distribution is concerned, suggest that the N–CH3 cleavage reaction might occur through an intermediate. Sudden decrease of the S1 lifetime at ∼700 cm−1 above the S1 origin is accompanied by the fragmentation of the Boltzmann-type low kinetic energy distribution. The appearance rate of this low-kinetic energy fragment turns out to be quite slow to give τ ∼ 5 ns compared to the S1 lifetime of ∼174 ps at the +806 cm−1 band, for instance, confirming previous findings that the S1 decay process starts to be overwhelmed by a new fast nonradiative transition in the corresponding excitation energy region. The lifetime at the S1 origin accessed by the two-photon absorption is firstly measured to give τ ∼ 8 ns. Using one and two photon absoption processes, a number of S1 vibronic bands are identified to give mode-dependent lifetimes spanning an enormously wide temporal range of 8 ns–5 ps in the quite narrow excitation energy region of 0–1800 cm−1 above the S1 origin. Understanding of the N-methylpyrrole dynamics on multidimensional excited-state potential energy surfaces governing energy dissipating processes will get much benefit from our detailed mode-specific lifetime measurements.

Objectives Anxiety disorders are the most common psychiatric disorders in adolescents and seem to occur the earliest among all forms of psychopathology. The aim of this study was to investigate the association of anxiety severity with health risk behaviors and mental health in adolescents. Methods Data from the 2020 Korean Youth Risk Behavior Web-Based Survey were analyzed. A total of 54948 adolescents responded to the 7-item Generalized Anxiety Disorder Scale (GAD-7) for the assessment of their anxiety severity as well as to the mental health and health risk behavior survey. Logistic regression analysis, t tests, and variance analysis of a complex sample general linear model were used to examine the association of anxiety severity with health behaviors and mental health. Results After statistical adjustment for sociodemographic characteristics, the subjects in the severe anxiety group were significantly more likely to be current smokers (odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.72-2.50), current drinkers (OR: 1.91, 95% CI: 1.67-2.19), experience habitual substance use (OR: 10.89, 95% CI: 8.22-14.42), have sexual intercourse (OR: 2.10, 95% CI: 1.76-2.51), and have unprotected intercourse (OR: 2.21, 95% CI: 1.67-2.92) than those in the normal group. Anxiety severity negatively correlated with sleep satisfaction and happiness, but positively correlated with stress perception, loneliness, depressive symptoms, and suicidality. Conclusion Adolescent anxiety is associated with health risk behaviors and poor mental health. Thus, early screening and intervention for anxiety in adolescents could contribute to the management and coping of youth health risk behaviors in the community.

PURPOSE To investigate the clinical features and outcomes of diffuse large B-cell lymphoma (DLBCL) involving the eye and ocular adnexa in an East Asian population and emphasize the importance of prompt biopsy and treatment in unusually progressive ocular adnexal DLBCL for better visual outcomes. METHODS Retrospective case series of 38 patients diagnosed with DLBCL involving the eye and ocular adnexa between 1995 and 2018 at a single tertiary institution. RESULTS There were 38 patients (22 men, 16 women), 22 (57.9%) of which had ocular adnexal lymphoma (OAL) and 16 (42.1%), vitreoretinal lymphoma (VRL). The OAL group showed higher rates of unilateral involvement (p = 0.01) and localized disease presentation (p = 0.01). Thirteen (59.1%) of 22 OAL patients were primary diseases and 9 (40.9%) were secondary. Between primary and secondary OAL groups, there was no statistical difference in clinical characteristics such as age, gender and laterality (p = 0.47, p = 0.19 and p = 0.66, respectively). All secondary OAL cases were either disseminated or relapsed by definition and only two cases (15%) of primary OAL showed disseminated presentation (p

Prolongation of the picosecond Raman pump laser pulse in the femtosecond stimulated Raman spectroscopy (FSRS) setup is essential for achieving the high spectral resolution of the time-resolved vibrational Raman spectra. In this work, the 2nd-order diffraction has been firstly employed in the double-pass grating filter technique for realizing the FSRS setup with the sub-5 cm-1 spectral resolution. It has been experimentally demonstrated that our new FSRS setup gives rise to a highly-resolved Raman spectrum of the excited trans-stilbene, which is much improved from those reported in the literatures. The spectral resolution of the present FSRS system has been estimated to be the lowest value ever reported to date, giving Δν = 2.5 cm-1. National Research Foundation (NRF) Published version This work was financially supported by National Research Foundation (2018R1A2B3004534 and 2019R1A6A1A10073887). The authors would like to thank Prof. David W. McCamant and Dr. Zachary Piontkowski of University of Rochester for useful experiment advice.

Dynamic shaping of the adiabatic tunneling barrier in the S-H bond extension coordinate of several ortho-substituted thiophenols has been found to be mediated by low-frequency out-of-plane vibrational modes, which are parallel to the coupling vector of the branching plane comprising the conical intersection. The S-H predissociation tunneling rate (

Stereotactic radiosurgery such as Gamma Knife radiosurgery (GKRS) has been shown to have a good treatment effect for orbital cavernous venous malformation (CVM). However, radiation-induced retinopathy or optic neuropathy is a vision-threatening complication of orbital irradiation. Predicting the post-treatment visual outcome is critical. Clinical and radiological outcomes were investigated in 30 patients who underwent GKRS for orbital CVM between July 2005 and February 2020. Measurement of peripapillary retinal nerve fiber layer (pRNFL) thickness using optical coherence tomography (OCT) was obtained in 14 patients. The median clinical and radiological follow-up periods were 46.6 months (range, 15.9–105.8) and 27.5 months (range, 15.4–105.8), respectively. Twenty-eight patients underwent multisession (4 fractions) GKRS. The median cumulative marginal dose was 20 Gy (range, 16–24). Two patients underwent single-session GKRS. Marginal doses were 15 Gy and 10.5 Gy in each patient. The volume of CVM decreased in 29 (97%) patients. Visual acuity was improved in 6 (20%) patients and was stable in 22 (73%) patients. Visual field defect and exophthalmos were improved in all patients. Serial investigation of OCT showed no statistically significant difference in pRNFL thickness after GKRS. Patients with normal average pRNFL thickness showed better visual recovery than patients with thin average pRNFL thickness. GKRS is an effective and safe treatment option for orbital CVM. The pRNFL thickness before GKRS can be a prognostic indicator for visual recovery in orbital CVM after GKRS.

Aim To investigate the chemical and mechanical properties of teeth affected by a 1-bp deletion (c.2688delT) in the DSPP gene. Methods and Materials Maxillary first premolars were extracted from the affected individual at age 9 years due to the orthodontic reason for crowding. A sample was imbedded in epoxy resin and sectioned buccolingually, after micro–computerized tomography (μCT) images were taken. Scanning Electron Microscopy (SEM), Energy Dispersive Spectrometry (EDS) and Vickers microhardness testing were also performed. Results μCT reconstruction and analysis showed an irregularly obliterated pulp chamber and an extremely small pulpal volume in the DGI-II sample. The mineral density and microhardness scores were smaller in the dentin of the DGI-II sample compared to the wild-type. Mg content was lower in the dentin of the DGI-II sample compared to the wild-type. Conclusion This study shows that dentin affected by a 1-bp deletion in DSPP has a reduced mineral density, diminished microhardness and reduced Mg content.

OBJECTIVE Orbital tumors are often surgically challenging because they require an extensive fronto-temporo-orbital zygomatic approach (FTOZ) and a multidisciplinary team approach to provide the best outcomes. Recently, minimally invasive endoscopic techniques via a transorbital superior eyelid approach (ETOA) or endoscopic endonasal approach (EEA) have been proposed as viable alternatives to transcranial approaches for orbital tumors. In this study, the authors investigated the feasibility of 360° circumferential access to orbital tumors via both ETOA and EEA. METHODS Between April 2014 and June 2019, 16 patients with orbital tumors underwent either ETOA or EEA at the authors’ institution. Based on the neuro-topographic “four-zone model” of the orbit with its tumor epicenter around the optic nerve in the coronal plane, ETOA (n = 10, 62.5%) was performed for tumors located predominantly superolateral to the nerve and EEA (n = 6, 37.5%) for those located predominantly inferomedial to the nerve. Eight patients (50%) presented with intraconal tumors and 8 (50%) with extraconal ones. The orbital tumors included orbital schwannoma (n = 6), cavernous hemangioma (n = 2), olfactory groove meningioma (n = 1), sphenoorbital meningioma (n = 1), chondrosarcoma (n = 1), trigeminal schwannoma (n = 1), metastatic osteosarcoma (n = 1), mature cystic teratoma (n = 1), sebaceous carcinoma (n = 1), and ethmoid sinus osteoma (n = 1). The clinical outcomes and details of surgical techniques were reviewed. RESULTS Gross-total resection was achieved in 12 patients (75%), near-total resection in 3 (18.8%), and subtotal resection in 1 (6.2%). Eight (88.9%) of the 9 patients with preoperative proptosis showed improvement after surgery, and 4 (66.7%) of the 6 patients with visual symptoms demonstrated improvement. Four (40%) of the 10 patients treated with ETOA experienced partial third nerve palsy immediately after surgery (3 transient and 1 persistent). There have been no postoperative CSF leaks or infections in this series. CONCLUSIONS Without transcranial approaches requiring temporalis muscle dissection and orbitozygomatic osteotomy, the selection of ETOA or EEA based on a concept of a four-zone model with its epicenter around the optic nerve successfully provides a minimally invasive 360° circumferential access to the entire orbit with acceptable morbidity.

In the absence of pathogenesis-targeted therapy in most types of primary dystonia, the current management strategy is largely symptomatic. Our aim was to comparatively evaluate the patients' perception of symptomatic benefits with the medical treatment of primary dystonia. We reviewed the medical records of 206 patients who received medical treatment upon diagnosis of primary dystonia. The patients were prescribed five different dystonia medications: clonazepam, trihexyphenidyl, nortriptyline, baclofen, and levodopa. Patients tried one type of medicine during each following week and whether each medication was beneficial was recorded in a binary fashion. Subgroups analysis was performed according to the body distribution, duration, ages at onset and treatment of dystonia. A total of 172 patients were included in the analysis. The majority (84%) had focal dystonia, most frequently cervical dystonia and blepharospasm. Clonazepam received the most favorable response (40%), followed by baclofen (20%) and trihexyphenidyl (20%). Patients with focal limb dystonia gave higher rate of positive responses to levodopa (24%) compared to other focal dystonia subgroups. Clonazepam, followed by baclofen and trihexyphenidyl is a useful pharmacologic option for primary dystonia. Levodopa can be considered for isolated limb dystonia.

Dermoid cysts may occur in the orbit, most commonly in the superolateral area. Malignant transformation of such lesions has been previously reported; however, most turn out to be squamous cell carcinoma. The authors' patient initially presented with mild proptosis and limitation in extraocular movements. Preliminary biopsy showed whitish amorphous material and abundant hairs filling the thin-walled cyst, consistent with dermoid cyst. The patient underwent tumor resection via lateral orbitotomy with bone window and transorbital endoscopic approach for the dural involvement. Final biopsy showed dermoid cyst with pilosebaceous malignant transformation showing p53 expression and 30% of Ki-67 index. Adjuvant radiotherapy was performed. To the best of the authors' knowledge, this is the first reported case of this type. Despite its rarity, there should always be a high index of suspicion and complete work-up for an accurate diagnosis.

Island-type tidal flats are located along the west and south coast of the Korean Peninsula on the east of the Yellow Sea. Due to the highly dynamic and complex combination of geological, oceanographic, and climatic conditions, the area is characterized by extremely dynamic past and ongoing sedimentary processes, thus representing one of the most intricate and diverse sedimentary and ecological systems in the world. Thousands of islands are scattered around a vast area adjacent to the land. Rapid macrotidal currents flow between these islands through tidal channels that are narrow or wide, short or long, and shallow or deep, changing their direction every 6 h. This creates one of nature’s most spectacular phenomena along the coast with coastal landform. Tidal sedimentation is also greatly influenced by the seasonal changes of the Asian monsoon climate regime, resulting in high geodiversity exposed to constant changes in hydrology and sediment supply. At the same time, the system has maintained a sustained sedimentation equilibrium, resulting in one of the world’s thickest Holocene intertidal mud deposits and most productive coastal ecosystems. The study area comprises four serial sites, each with different geological and geomorphic features. It also forms a single sedimentary circulation system between the source and one of the final sinks. The Korean tidal flat system therefore demonstrates unique and outstanding coastal landforms with ongoing dynamic and sustainable coastal processes, making it a potential inscription on the UNESCO World Heritage List.

A major advantage of shared transformer/reactor is their ability to reduce weight and volume. It is characterized by the fact that it can use only one support for each device. At this time, the distances between the transformer and the reactor that are apart from each other become very close to each other, and an obstacle element is generated. We found a difference in the value of the inductance and the part where the output decreases slightly. However, if it solves this little problem, it can use the devices with a slightly lighter weight and smaller volume for the desired output and efficiency. The core of this paper is presented a new form of existing devices, and the study of interrelationships is presented.

Among a variety of methods for studying the ultrafast carrier dynamics in the solid-state materials, time-resolved photoemission electron microscopy (PEEM) has been regarded as a unique tool which can simultaneously achieve the femtosecond time resolution as well as non-diffraction-limited lateral spatial resolution, hence providing spatiotemporally resolved information on surfaces with structural heterogeneities [1]. When combined with an electron time-of-flight analyzer in the form of a delay-line detector [2], PEEM can be further extended to provide spectroscopic information. The consequent energy-resolved momentum-space images acquired at selected microscopic regions can be mapped, hence permitting the real-time visualization of the evolving photorelaxation dynamics of the band structure of solid-state materials. Here, preliminary spectromicroscopic results obtained from the time-resolved PEEM setup will be presented, and further on-going efforts to build a femtosecond megahertz-repetition-rate extreme ultraviolet radiation source will be introduced. Published version

Purpose To describe the clinical outcomes of eye-preserving surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma. Methods Thirty-seven patients with lacrimal gland carcinoma who underwent eye-preserving surgery were studied. Results At last follow up, 32 patients were alive without disease, 3 patients were alive with disease with distant metastasis, 1 patient had died of disease, and 1 patient had died of other cause. The 5-year recurrence-free survival rate was worse in patients without than in patients with adjuvant radiotherapy (p = 0.001) and worse in patients with T3-T4 tumors than in patients with T1-T2 tumors (p = 0.027). At last follow up, 25 patients (68%) had visual acuity of 20/40 or better. Conclusions In patients with lacrimal gland carcinoma, eye-preserving surgery and adjuvant radiotherapy is associated with reasonable local control rates and visual and ocular function. Postoperative adjuvant radiotherapy seems to enhance local control rates.

Seoraksan Mountains in the Republic of Korea are presented as an area of outstanding geodiversity combining rock-controlled granite landforms, inherited cold-climate landforms and highly active contemporary geomorphological processes. Three generations of granites, ranging in age from Proterozoic to Cretaceous, are present and each of these supports distinctive morphology. Cretaceous granites are associated with most spectacular features such as domes and towers, fins, long rock slopes, and fluvial gorges. The latter host abundant waterfalls of different types, potholes, and bedrock channels. While no clear glacial landforms exist in Seoraksan, widespread blockfields, blockslopes, and blockstreams constitute the cold-climate legacy of potentially important palaeoclimatic significance. Slope steepness and extreme rainfall events are the decisive factors to explain frequent mass movements which leave visible erosional and depositional evidence on slopes and in valley floors. The geodiversity of Seoraksan makes the area highly suitable for outdoor geo-education and it is also argued that the area represents a highly diverse, non-glaciated mountainous geomorphological system that integrates source and sink areas and is of exceptional value and extraordinary scenic beauty.

The Quaternary Hantangang River Volcanic Field (HRVF) in the central part of the Korean Peninsula hosts unique volcanic landforms associated with fluvial topography. The volcanic field consists of a series of basaltic lava flows, ca. 0.1 to 0.6 Ma old, which originated from two source vents in DPRK (Democratic People’s Republic of Korea; North Korea) and flowed along a 110 km long stretch of paleo-river channels to the terminus in the northern part of ROK (Republic of Korea; South Korea). Afterwards, the lavas were eroded by the re-established river system, producing an array of precipitous exposures of columnar-jointed lavas along the channel walls, a number of waterfalls, and other fluvial landforms. The Hantangang River National Geopark was established in 2015 based on the volcanic geoheritage values of the region. Eighteen geosites in the geopark show high geodiversity and can be divided into five major groups of geotopes, including (1) volcanic landforms, (2) fluvial landforms, (3) pre-Quaternary basement rocks, (4) Quaternary deposits associated with archeological ruins, and (5) warm spring. Several geosites are related to ecological, cultural, and historical features. Here, we provide field-based documentations of the geoheritage values of these geotopes, regarding (1) the processes of terrestrial lava flows along a river valley, (2) landform evolution through the interplay between lava flows and fluvial erosion, and (3) the relationship between geological processes and ecological, historical, cultural, and archeological values. The geoheritage values of the Quaternary HRVF may justify for a UNESCO Global Geopark status in the future.

Interest in autoimmune encephalitis has been growing since the discovery of various autoimmune antibodies, such as N‐methyl D‐aspartate receptors antibody and leucine‐rich glioma‐inactivated 1 antibody. However, in contrast to autoimmune encephalitis associated with dysregulated adaptive immunity in the brain, the question of whether innate immunity‐mediated autoinflammatory diseases exist in the brain has drawn much attention. Herein, we report a patient with microglia‐dominant acute autoinflammatory encephalitis successfully treated with anakinra, an including interleukin‐1 receptor blocker. In comparison to systemic autoinflammatory disease, we term this encephalitis cerebral autoinflammatory disease. Cerebral autoinflammatory disease could suggest new conceptual approaches to patients previously diagnosed with an unspecified encephalitis.

Distal-less homeobox 3 (Dlx3), a member of the Dlx family of homeobox proteins, is a transcriptional activator of runt-related transcription factor 2 (Runx2) during osteogenic differentiation. It has been demonstrated that forced expression of Runx2 induces an osteogenic program and ectopic calcification in muscles. Therefore, it would be reasonable to predict that Dlx3 also affects myogenic differentiation. The relationship between Dlx3 and myogenesis, however, remains poorly understood. Therefore, in this study, the role and regulation of Dlx3 during myogenic differentiation were investigated. Expression level of Dlx3 was downregulated in human mesenchymal stem cells (MSCs), mouse MSCs, and C2C12 cells cultured in myogenic medium. Dlx3 level was inversely correlated with myogenic differentiation 1 and the muscle-specific microRNA, microRNA-133 (miR-133). The expression level of Runx2 was closely regulated by Dlx3 even under myogenic conditions. Overexpression of Dlx3 markedly downregulated expression levels of myogenic transcription factors and myotube formation in C2C12 cells, whereas Dlx3 knockdown enhanced myogenic differentiation. The Dlx3 3'-untranslated region (3'-UTR) has two potential binding sites for miR-133. Luciferase reporter assays demonstrated that Dlx3 is a direct target of miR-133a and miR-133b, and that the two target sites are redundantly active. Taken together, these results suggest that Dlx3 is a negative regulator of myogenic differentiation and that miR-133a and miR-133b enhance myogenic differentiation, partly through inhibition of Dlx3 expression via direct targeting of the Dlx3 3'-UTR.

Purpose Undercorrected blepharoptosis can be encountered after frontalis sling operation. Revision surgery for undercorrection has commonly involved introducing a new sling material. We describe and evaluate a simple surgical technique to correct undercorrection by adjusting preexisting fascia. Methods This is a retrospective interventional case series of patients undergoing sling revision between February 2010 and February 2017. Skin incision was made on the previous incision line. Careful dissection was performed superiorly to identify a preexisting fascia, and the dissected fascia was reattached to the tarsal plate using nonabsorbable sutures with adjustments for eyelid height and contour. The success of the procedure was defined as less than 1 mm of difference in the marginal reflex distance 1 of both eyes without any contour deformity. Results Twenty-one eyelids in 18 patients were included with a mean follow-up of 17.5 months (range 6-48) and a mean age of 14.7 years (range 5-57). All patients had undergone frontalis sling with autogenous fascia lata for congenital ptosis. Undercorrection due to recurrent ptosis was found in 12 eyelids, and contour deformity such as temporal ptosis was found in 9 eyelids. The mean time interval between previous frontalis sling operation and sling revision was 6.8 years. Nineteen patients (90.5%) achieved surgical success and a cosmetically acceptable appearance. Conclusion Sling revision is a simple and effective method with low perioperative morbidity for cases of undercorrection or contour deformity following frontalis sling operation using autogenous fascia lata, even long after the primary procedure.

Myoblast fusion is critical for muscle growth, regeneration, and repair. We previously reported that the enzyme peptidyl-prolyl cis-trans isomerase NIMA interacting 1 (Pin1) is involved in osteoclast fusion. The objective of this study was to investigate the possibility that Pin1 also inhibits myoblast fusion. Here, we show the increased number of nuclei in the Pin1+/- mice muscle fiber compared to that in wild-type mice. Moreover, we show that low dose of the Pin1 inhibitor dipentamethylene thiuram monosulfide treatment caused enhanced fusion in C2C12 cells. The R-Smads are well-known mediators of muscle hypertrophy and hyperplasia as well as being substrates of Pin1. We found that Pin1 is crucial for maintaining the stability of Smad3 (homologues of the Drosophila protein, mothers against decapentaplegic (Mad) and the Caenorhabditis elegans protein Sma). Our results show that serine 204 within Smad3 is the key Pin1-binding site during inhibition of myoblast fusion and that both the transforming growth factor-β receptor and extracellular signal-regulated kinase (ERK)-mediated phosphorylation are required for the interaction of Pin1 with Smad3. These findings suggest that a precise level of Pin1 activity is essential for regulating myoblast fusion during myogenesis and muscle regeneration.

Purpose To report the long-term outcomes of using acellular dermal allograft (ADA) as a tarsal substitute for reconstruction of large full-thickness eyelid defects where ipsilateral or contralateral eyelid donor tissue was either not available or tarsoconjunctival transfer was insufficient to cover the full extent of the defect. Methods A retrospective review of a consecutive series of 10 patients between May 2003 and April 2012. Main outcome measures were anatomical and functional outcomes and complications. Results The study cohort included 4 males and 6 females with a mean age of 48.1 years (range 31-64 years). Indications for reconstruction were extensive full-thickness eyelid defects (upper or lower or both) resulting from tumor excision (n = 6), traumatic eyelid defect (n = 2), electrical burn (n = 1), and eyelid necrosis (n = 1). The mean postoperative follow-up was 84.3 months (range 33-164 months). The reconstructive procedure included a variety of techniques using ADA as the posterior lamellar graft. Overall, 7 patients achieved excellent anatomical, cosmetic, and functional results. Reoperation was required in 3 patients (for postoperative upper lid retraction, upper lid entropion, and lower fornix reconstruction) despite acceptable initial results. There were no intraoperative complications, postoperative allergic or immunologic rejection associated with the use of allograft, nor any long-term sequelae. Conclusion The extensive upper and lower eyelid defects with large vertical component can be successfully repaired using ADA as a tarsal substitute. The results of our study with long-term follow-up indicate excellent functional and cosmetic outcomes with minimal morbidity.

Yongcheon Cave is a typical lava tube cave, which formed by multiple flows of lava during the Late Quaternary. However, it is also a lime-decorated cave with numerous splendid carbonate speleothems along two parts of the passage. This paper deals with these special unique features of the cave together with their formation processes and the geoheritage significance based on detailed investigation of overlying carbonate sand dunes and speleothems. The cave is about 3360 m long, composed of 2590-m-long main passage and about 370-m-long branch passages. Because the cave contains unexplored passages at the downstream end, it is estimated that the total length can be at least about 400 m longer. The cave contains various microtopographic characteristics such as multiple and various forms of lava coatings on the surface as well as dented features by thermal erosion. They include pahoehoe and aa lavas, rockfalls, lava falls, lava benches, gutters with overflowed lava levees, tube-in-tubes, and lava benches on the floor. Lava flowlines are prominent on the wall, and also, anastomosing branches, lava bridges, and multiple leveled floors are other distinctive morphological features. Carbonate sand dunes were formed by transportation of beach sands nearby and partially overlie two parts of the cave passage. Carbonate sediments are medium sand-sized and are mostly composed of mollusk and coralline red algae fragments up to 60~70% with a minor contribution of benthic foraminifers, echinoderms, bryozoans, and volcanic rock fragments, which may well represent typical temperate carbonate constituents elsewhere. Beach sediments, the source of carbonate dune sands, also show the similar texture and composition. This suggests that the dune sands were transported onto the area by wind along the valleys. Previous age dating results of four carbonate sand dunes including several paleosol layers imply the formation ages of the dunes at each site since the deposition of carbonate sands in shallow seas between 4700 and 6000 years BP due to full deglaciation after Last Glacial Maximum. Carbonate speleothems began to grow in the cave after the deposition of dunes. Detailed mapping of the cave and dune fields strongly suggest that the dune distributions are directly related to the formation of carbonate speleothems. A variety of carbonate speleothems are found in Yongcheon Cave such as soda straws, stalactites, stalagmites, columns, rimstones, flowstones, cave corals, draperies (curtains and bacon sheets), cave pearls, shelfstones, and moonmilks. However, many carbonate speleothems show erratic morphologies that cannot be seen in any limestone caves elsewhere. It is because the formation of erratic speleothems is directly influenced by distribution of plant roots which helped to transport rainwater into the cave and to precipitate calcite mineral. Their unique abundance of carbonate speleothems providing splendid scenic values as well as Jeju’s special geological conditions for their formation is considered to be the outstanding universal value for the World Heritage site.